Revised Atlanta Classification of Acute Pancreatitis . The CT severity index (CTSI) combines the Balthazar grade ( points) with the. Predict complication and mortality rate in pancreatitis, based on CT findings ( Balthazar score). A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the
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Fifty patients with acute pancreatitis admitted to our hospital during the period of March to September were included in the study. Optimal cut-offs for these scoring systems and the area under the curve AUC were evaluated based on the receiver operating characteristics ROC curve and these scoring systems were compared prospectively.
Of the 50 cases, 14 were graded as severe acute pancreatitis. Pancreatic necrosis was present in 15 patients, while 14 developed persistent organ failure and 14 needed intensive care unit ICU admission. APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral, especially in resource-limited developing countries.
Acute pancreatitis is a common and frequent inflammatory disorder of the pancreas with variable involvement of other regional tissues or remote organ systems [ 1 ].
Early diagnosis and precise staging of disease severity are important goals in the initial evaluation and management of acute pancreatitis. While patients with mild acute pancreatitis can be managed with fluid resuscitation and supportive care, those with severe acute pancreatitis require maximal non-operative care and nutritional support in an intensive care unit ICU.
Due to the risk of rapid deterioration in severe acute pancreatitis, the assessment of severity becomes crucial to a clinician [ 3 ]. A clinically based classification system for acute pancreatitis was established in the International Symposium on Acute Pancreatitis in Atlanta, Georgia, in However, criticism of the Atlanta severity classification system was growing because it was retrospective, the duration of organ failure was unspecified and local complications did not seem to increase mortality.
The Atlanta classification was revised via an international, web-based consensus in that provided clear definitions to classify acute pancreatitis using easily pancreatitus clinical and radiologic criteria. Greater emphasis was laid on organ failure and severity was graded as mild, moderately severe and severe acute pancreatitis [ 4 ].
Several multi-factorial scoring systems based on clinical and biochemical data have been used over the past few decades. Each of these scoring systems has its own limitations including the low sensitivity and specificity, complexity of the scoring system as well as inability to obtain a final score until 48 hours after admission [ 5 ].
With the advent of contrast enhanced scans, there has been major improvement in the grading system. Attenuation values of pancreatic parenchyma during an intra-venous bolus study pacnreatitis be used as an indicator of pancreatic necrosis and as a predictor of disease severity [ 67 ].
The sensitivity and specificity for diagnosing pancreatic necrosis increase with greater degrees of pancreatic non-enhancement, and complications have also been shown to correlate with the degree of non-enhancement [ 8 ]. However, early CT scans often fail to identify developing apncreatitis until such areas are better demarcated, which may become evident only 2—3 days after the initial clinical onset of symptoms.
Inmodified CTSI was introduced to improve the staging of acute pancreatitis. There have been few studies comparing these prognostic scoring pancraetitis based on the revised Atlanta classification. This study aimed to assess and compare the prediction of severity of acute pancreatitis based on multi-factorial scoring systems viz.
Demographic, clinical, biochemical and radiographic data were prospectively collected from 50 patients admitted over the duration of March to September in the Department of General Surgery in Pt. The study was limited to 50 patients, since the it had to be completed during a fixed timeframe of 2 years and only patients admitted and treated under the direct supervision of the authors were considered.
The diagnoses of acute pancreatitis was based on the presence of two of the following three criteria: Patients who presented to the emergency department and were diagnosed as having acute pancreatitiss based on the criteria mentioned above were informed about the study and written consent was taken. Patients who were diagnosed to have chronic pancreatitis based pacreatitis their previous hospital records or found to have features of chronic pancreatitis upon radiological investigations during the course of their stay such as pancreatic dtsi, dilated pancreatic duct, areas of atrophy and pseudocysts were excluded from the study.
After detailed history and physical examination, laboratory investigations were sent at the time of admission—arterial blood gas analysis, pancrearitis, kidney function test, liver function test, serum electrolytes, cttsi amylase, serum lipase and complete hemogram.
All patients underwent abdominal ultrasonography at admission and contrast enhanced pancreatic protocol CT scan 72 hours after symptom onset. BISAP was calculated within first 24 hours of admission.
Patients with pancreatktis acute pancreatitis had neither local complications nor pxncreatitis failure. Patients pancreatitie moderately severe acute pancreatitis had transient organ pancreatitix or local complications or both, whereas patients with severe acute pancreatitis had persistent organ failure.
Organ failure was defined based on the Modified Marshall scoring system.
CT Severity Index (Pancreatitis)
Local complications included pancreatic necrosis, acute fluid collections, pseudocyst, acute necrotic collections and walled-off necrosis. Inotropes and colloids were added if the patients failed to respond to crystalloids. All patients were catheterized to monitor the urine output and ascertain the adequacy of resuscitation. Central venous access was obtained for patients who failed to respond to initial resuscitation measures to monitor the central venous pressure and guide further fluid management.
A nasogastric tube was placed for all patients. All patients were kept nil per oral for the first 24 hours. Subsequently, patients were examined daily and enteral feeding by means of a nasogastric tube or orally was initiated as soon as features of ileus resolved.
Patients with pancreatic necrosis who failed to improve were planned for necrosectomy and open drainage. A total of two patients underwent surgical intervention for pancreatic necrosis. Patients with cholelithiasis underwent pre-anesthetic checkup and pre-operative work-up prior to discharge and planned to undergo cholecystectomy after 6 weeks as per institutional protocol.
Facilities for endoscopic retrograde cholangiopancreatography ERCP are not available at our institute. Severity of the disease was evaluated in terms of ICU admission, length of hospital stay, final grade as per Atlanta classification and presence of pancreatic necrosis.
Data were collected prospectively in a Microsoft Excel Database. Categorical variables were expressed as absolute numbers and proportions.
Sensitivity, specificity, positive predictive value pancreatitsi negative predictive value were calculated for each scoring system. AUC values were compared for statistical significance using De Long test. The mean age of patients included in the study was The mean length of stay in the study was 6.
The Radiology Assistant : Pancreas – Acute Pancreatitis
The length of stay for those graded as having mild acute pancreatitis was 5. Based on the highest sensitivity and specificity values generated from the ROC curves, the following cut-offs were selected for further analysis: Predictive value of different scoring systems for pancreatic necrosis, organ failure and ICU admission.
Acute pancreatitis is a common ailment encountered by physicians in emergency departments all over the world. It is critical to identify patients with severe acute pancreatitis who will benefit from early intensive care therapy. In most cases, it is difficult to assess the severity clinically alone.
The mean age of the study population was The higher incidence of gall stone disease and female preponderance in our study as compared to similar studies in other parts of India could be attributed to the higher prevalence of gall stone disease in northern India, where our institute is located [ 1011 ]. All three patients were graded as having severe acute pancreatitis based on Atlanta criteria. The cause of death in all three patients was multiple organ failure.
Considering the poor availability of CT scanning and ICU facilities in our country, we aimed to compare various prognostic scoring systems, which may aid in decision making regarding which patients need to be referred to a tertiary care center at the earliest. The AUC for modified CTSI was the highest for all the four parameters considered as markers for severity of acute pancreatitis, namely pancreatic necrosis 0. However, it performed poorly compared to these scoring systems in predicting severity and mortality, and contrast enhanced CT was performed within 3 days of onset, which may reduce its sensitivity.
Moreover, the study population was exclusively limited to patients with hyperlipidemic acute pancreatitis. The current study has a few limitations. The sample size is too small to make definitive comparisons amongst the scoring systems. The study population consists mostly of pancreatitis secondary to gall stone disease and therefore no meaningful comparisons can be made amongst the various scoring systems for different etiologies.
Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Close mobile search navigation Article navigation. Department of Surgery, Pt. Pro- and anti-inflammatory cytokines during acute severe pancreatitis: Parisian Study Group on Acute Pancreatitis.
Classification of acute pancreatitis— Early detection of acute fulminant pancreatitis by contrast-enhanced computed tomography. How do imaging methods influence the surgical strategy in acute pancreatitis?
Comparative evaluation of the modified CT severity index in assessing severity of acute pancreatitis.
CT Severity Index (Pancreatitis) | Calculate by QxMD
Predicting morbidity and mortality in acute pancreatitis in an Indian population: A prospective evaluation of the Bedside Index for Severity in Acute Pancreatitis score in assessing mortality and Intermediate marker of severity in acute pancreatitis. Modified computed tomography severity index for evaluation of acute pancreatitis and its correlation with clinical outcome: A modified CT severity index for evaluating acute pancreatitis: Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis.
For commercial re-use, please contact journals. Email alerts New issue alert. Receive exclusive offers and updates from Oxford Academic. More on this topic Clinical outcomes and prognostic significance of early vs. Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis.
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